1. An Innovative Program to Teach First and Second Year Medical Students about the Impact of Chronic Illness on Patients and Families Sharon A. Mueller, RN, MA; Kendall Reed, DO; Mary- Pat Wohlford-Wessels, Ph.D. Des Moines University- Osteopathic Medical Center Des Moines, Iowa

2. The Chronic Care Program: C.O.P.E./Community Osteopathic Professional Education Program at Des Moines University C.O.P.E./Community Osteopathic Professional Education Program at Des Moines University

3. Abstract: The Chronic Care /Community Osteopathic Professional Education/C.O.P.E. program was implemented in the Spring of 2004. It was developed to introduce first and second year medical students to patients dealing with chronic illness, while fostering compassionate health care.

4. C.O.P.E. This elective has grown to the point that 30% of first and second year students are enrolled. This elective has grown to the point that 30% of first and second year students are enrolled. Patients enrolled are referred by community physicians and caregivers. Patients enrolled are referred by community physicians and caregivers. Students learn more about chronic illness as it affects real people. Students learn more about chronic illness as it affects real people. Students study a variety of diseases. Students study a variety of diseases.

5. C.O.P.E. Students learn about diseases such as: congestive heart disease, chronic obstructive pulmonary disease, diabetes, multiple sclerosis and Parkinsons Disease. Students learn about diseases such as: congestive heart disease, chronic obstructive pulmonary disease, diabetes, multiple sclerosis and Parkinsons Disease. Students learn about the psychological, financial and interpersonal impact of these various diseases, in addition to the traditional curriculum. Students learn about the psychological, financial and interpersonal impact of these various diseases, in addition to the traditional curriculum.

6. Competencies: A survey of 1,236 physicians, revealed that chronic disease training was less than adequate (1). Sixteen course directors at U.S. medical schools concluded that schools should include specific methods for the development of chronic care competencies among students (2). Dr. Michael Whitcomb, in Academic Medicine suggests a specialty be developed. A survey of 1,236 physicians, revealed that chronic disease training was less than adequate (1). Sixteen course directors at U.S. medical schools concluded that schools should include specific methods for the development of chronic care competencies among students (2). Dr. Michael Whitcomb, in Academic Medicine suggests a specialty be developed.

7. Career Choices: Fewer students are choosing a career in Primary Care, therefore, Dr. Whitcomb suggests a type of generalist specialty to be name Practitioner of Comprehensive Medicine (3) Fewer students are choosing a career in Primary Care, therefore, Dr. Whitcomb suggests a type of generalist specialty to be name Practitioner of Comprehensive Medicine (3)

9. How does my education apply to real people?? This is the question many students ask, as they attempt to master the basic sciences and apply them to clinical practice. This is the question many students ask, as they attempt to master the basic sciences and apply them to clinical practice. How to add more to an already crowded curriculum??? How to add more to an already crowded curriculum??? As an elective, students signed up in large numbers, to add to their understanding of real patients with real illnesses As an elective, students signed up in large numbers, to add to their understanding of real patients with real illnesses

10. Referrals from Community: Physicians and Caregivers from the Des Moines community refer patients. Physicians and Caregivers from the Des Moines community refer patients. Students are sent in pairs to visit patients in their homes, Drs offices, treatments centers and the hospital. Students are sent in pairs to visit patients in their homes, Drs offices, treatments centers and the hospital. Physicians and Caregivers are in a unique position to instruct and model how to provide appropriate care to these individuals. Physicians and Caregivers are in a unique position to instruct and model how to provide appropriate care to these individuals.

11. Documentation: Students are required to visit every 4-6 weeks and document their visits in SOAP note format. Students are required to visit every 4-6 weeks and document their visits in SOAP note format. Students are encouraged to journal about their experiences. Students are encouraged to journal about their experiences. Students also meet in small groups with faculty facilitators every other month, to discuss their various experiences Students also meet in small groups with faculty facilitators every other month, to discuss their various experiences

13. Relationships: Students get to know their patients really well and are able to share their insights into chronic care, reflect on what they have learned and set goals for future visits. Students get to know their patients really well and are able to share their insights into chronic care, reflect on what they have learned and set goals for future visits.

14. Appreciation Reception: The past two years, we have held an Appreciation Reception, inviting patients, caregivers, physicians, faculty and staff to participate. This year we had a speaker from the community about Chronic Care of the patient with Pulmonary Disease. The past two years, we have held an Appreciation Reception, inviting patients, caregivers, physicians, faculty and staff to participate. This year we had a speaker from the community about Chronic Care of the patient with Pulmonary Disease.

15. What we have Learned: Each year, in May, we administer an evaluation on Blackboard. This includes such questions as, the importance of the subject, value of the small group, effectiveness of the facilitators, ability to interact with and observe patients and their significant others during the course of their illness, relationship with physicians, etc.. The following slide shows last years results. Each year, in May, we administer an evaluation on Blackboard. This includes such questions as, the importance of the subject, value of the small group, effectiveness of the facilitators, ability to interact with and observe patients and their significant others during the course of their illness, relationship with physicians, etc.. The following slide shows last years results.

16. EVALUATION:

18. Discussion: In assessing the evaluations, it was decided to add a bit more structure to the curriculum, i.e., have case presentations at the end of the year; change the course to credit, vs. no-credit, along with a reference to participation in the students Deans letter, prior to rotations/residencies. In assessing the evaluations, it was decided to add a bit more structure to the curriculum, i.e., have case presentations at the end of the year; change the course to credit, vs. no-credit, along with a reference to participation in the students Deans letter, prior to rotations/residencies. We added DPT students to the mix, due to the support given by Facilitators from the PT Dept. We added DPT students to the mix, due to the support given by Facilitators from the PT Dept. Also, this adds a nice mix of viewpoints. Also, this adds a nice mix of viewpoints.

19. Discussion Contd: We applied for a Grant, however, we were approved, but not funded, due to cutbacks in the budget for NIH and various other agencies. We applied for a Grant, however, we were approved, but not funded, due to cutbacks in the budget for NIH and various other agencies. The University continues to support the program, due to its popularity and usefulness, over 100 students continue to be enrolled, each semester – more than any other elective. The University continues to support the program, due to its popularity and usefulness, over 100 students continue to be enrolled, each semester – more than any other elective. The program is seen as necessary. The program is seen as necessary.

20. Restructuring: Intitially the program/C.O.P.E., fell under the auspices of the Dean of the C.O.M., however, it was decided it would fit well in the Geriatrics Department, where we also have a number of electives and the Geriatric Education Center (GEC) at DMU. The Medical Director is also involved with Hospice of Central Iowa, an added benefit being end-of-life issues. Intitially the program/C.O.P.E., fell under the auspices of the Dean of the C.O.M., however, it was decided it would fit well in the Geriatrics Department, where we also have a number of electives and the Geriatric Education Center (GEC) at DMU. The Medical Director is also involved with Hospice of Central Iowa, an added benefit being end-of-life issues.

21. References: 1) Darer, J.D., Hwang, W., Pham, H.H., Bass, E.B., Anderson, G. (2004). More training Needed in Chronic Care: A Survey of US Physicians. Academic Medicine, 79(6); 541-8. 1) Darer, J.D., Hwang, W., Pham, H.H., Bass, E.B., Anderson, G. (2004). More training Needed in Chronic Care: A Survey of US Physicians. Academic Medicine, 79(6); 541-8. 2) Bodenheimer, T. (2003). Interventions to improve Chronic Illness Care: Evaluating their Effectiveness. Disease Management, 6(2); 63- 71. 2) Bodenheimer, T. (2003). Interventions to improve Chronic Illness Care: Evaluating their Effectiveness. Disease Management, 6(2); 63- 71.

22. References contd: 3) Whitcomb, Michael E. (2005). Whos Going to Take Care of the Folks? Academic Medicine, 80(9); 789-90. 3) Whitcomb, Michael E. (2005). Whos Going to Take Care of the Folks? Academic Medicine, 80(9); 789-90. 4) Bankston, Patrick W. (Class of 2006-07). Indiana University School of Medicine-North- west. Academic Program, Problem-Based Learning (PBL) Curriculum. The 7 Steps of the PBL Curriculum (Doctor-Patient Relationship- dispersed throughout the first year). Gen. Info. 4) Bankston, Patrick W. (Class of 2006-07). Indiana University School of Medicine-North- west. Academic Program, Problem-Based Learning (PBL) Curriculum. The 7 Steps of the PBL Curriculum (Doctor-Patient Relationship- dispersed throughout the first year). Gen. Info.

23. THE END!!!

24. AACOM Conference: Baltimore, MD, June 22-25, 2006 Baltimore, MD, June 22-25, 2006 Thank You very much: Thank You very much: Sharon.Mueller@dmu.edu, 515-271-1094 Sharon.Mueller@dmu.edu, 515-271-1094 Sharon.Mueller@dmu.edu Director, Chronic Care, Des Moines University Director, Chronic Care, Des Moines University 3200 Grand Avenue, Des Moines, IA 50312 3200 Grand Avenue, Des Moines, IA 50312